What Is a Rectovaginal Fistula and How’s It Treated?

A fistula is an abnormal connection between two organs. In the case of a rectovaginal fistula, the connection is between a woman’s rectum and vagina. The opening allows stool and gas to leak from the bowel into the vagina.

An injury during childbirth or surgery can cause this condition.

A rectovaginal fistula can be uncomfortable, but it’s treatable with surgery.

Complications during childbirth. During a long or difficult delivery, the perineum can tear, or your doctor might make a cut in the perineum (episiotomy) to deliver the baby.

Inflammatory bowel disease (IBD).Crohn’s disease and ulcerative colitis are types of IBD. They cause inflammation in the digestive tract. In rare cases, these conditions can increase your risk of developing a fistula.

Cancer or radiation to the pelvis. Cancer in your vagina, cervix, rectum, uterus, or anus can cause a rectovaginal fistula. Radiation to treat these cancers can also create a fistula.

Surgery. Having surgery on your vagina, rectum, perineum, or anus can cause an injury or infection that leads to an abnormal opening.

About 0.5 percent of women who have vaginal deliveries worldwide get this condition. However, it’s much less common in developed countries like the United States. Up to 10 percent of people with Crohn’s disease develop rectovaginal fistula.

Rectovaginal fistula can be difficult to talk about. Yet it’s important to tell your doctor about your symptoms so you can get treated.

Your doctor will first ask about your symptoms and perform a physical exam. With a gloved hand, the doctor will check your vagina, anus, and perineum. A device called a speculum may be inserted into your vagina to open it up so your doctor can see the area more clearly. A proctoscope can help your doctor see into your anus and rectum.

Anorectal or transvaginal ultrasound. During this test, a wand-like instrument is inserted into your anus and rectum, or into your vagina. An ultrasound uses sound waves to create a picture from inside your pelvis.

Methylene enema. A tampon is inserted into your vagina. Then, a blue dye is injected into your rectum. After 15 to 20 minutes, if the tampon turns blue, you have a fistula.

Barium enema. You will get a contrast dye that helps your doctor see the fistula on an X-ray.

The main treatment for a fistula is surgery to close the abnormal opening. However, you can’t have surgery if you have an infection or inflammation. The tissues around the fistula need to heal first.

Your doctor might suggest that you wait for three to six months for an infection to heal, and to see if the fistula closes on its own. You’ll get antibiotics to treat an infection or infliximab (Remicade) to bring down inflammation if you have Crohn’s disease.

Rectovaginal fistula surgery can be done through your abdomen, vagina, or perineum. During the surgery, your doctor will take a piece of tissue from somewhere else in your body and make a flap or plug to close the opening. The surgeon will also fix the anal sphincter muscles if they’re damaged.

Some women will need a colostomy. This surgery creates an opening called a stoma in your belly wall. The end of your large intestine is put through the opening. A bag collects wastes until the fistula heals.

You may be able to go home on the same day as your surgery. For some types of surgery, you’ll need to stay overnight in the hospital.

Sometimes a rectovaginal fistula closes up on its own. Most of the time, surgery is needed to correct the problem.

The odds of surgery success depend on what type of procedure you have. Abdominal surgery has the highest rate of success, at 95 percent. Surgery through the vagina or rectum has about a 55 percent success rate. If the first surgery doesn’t work, you will need another procedure.

Medically reviewed by Karen Gill, MD on November 16, 2017 — Written by Stephanie Watson